| Doctor Name: | LISA M PROVENZA-TABAK |
| NPI Number: | 1871583948 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.C. |
| License Number: | 2661 |
| Business Practice Address: | 3680 Starrs Centre Dr Canfield, OH - 444069514 |
| Business Phone Number: | 3307020500 |
| Business Fax Number: | 3307050575 |
| Mailing Address: | 3680 Starrs Centre Dr, CANFIELD |
| State: | OH |
| Postal Code: | 444069514 |
| Phone Number: | 3307020500 |
| Fax Number: | 3307020575 |
| NPI Enumeration Date: | 10/28/2005 |
| NPI Last Update Date: | 06/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | 2661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |